Comorbidities are common in older patients with cancer. The Cumulative Illness Rating Scale for Geriatrics (CIRS-G, developed in 1992) provides a comprehensive assessment of comorbidities and is independently associated with the mortality rate, the hospital admission rate and functional limitations. Although the literature data indicate that the CIRS-G's reliability is good to very good, most of the studies were small and did not include cancer patients. Here, we evaluated the CIRS-G's reliability in a large, prospective cohort of cancer patients aged 70 or over. A stratified, random sample of 150 patients was used to assess inter-rater reliability, and a random sample of 30 patients was evaluated by two investigators to assess intra-rater reliability. For inter-rater reliability, the observed intraclass correlation coefficient (ICC) [95% confidence interval] of 0.53 [0.12-0.74] was substantially lower than the literature values. For intra-rater reliability, the ICC was 0.66 [0.40-0.82] for investigator 1 and 0.77 [0.54-0.89) for investigator 2. These findings suggest that applying the CIRS-G consistently across raters and centres may be challenging in real-world oncology settings for older patients with cancer. Revising the scoring guidelines could help improve its reliability.

The proportion of older adults in emergency departments continues to rise, posing significant organizational and medical challenges. At Ambroise-Paré Hospital (AP-HP), where 21 % of the 40,000 annual visits involve patients over the age of 75, an innovative solution has been developed: the establishment of a geriatrician position dedicated to the emergency department. This article provides an overview of geriatric emergency care in France, the specific challenges of caring for older adults in emergency settings, and the experience with the program implemented at Ambroise-Paré since November 2022-including the creation of a fast-track, the daily presence of a geriatrician in the short stay unit (SSU), and strengthened coordination with the regional geriatric care network.

In the context of ongoing societal and legislative debates in France on end-of-life care, the French Society of Geriatrics and Gerontology (SFGG) conducted a national survey to assess the perceptions and expectations of professionals working in the field of ageing regarding assisted dying (AD). An anonymous online questionnaire was distributed in November-December 2024 to all 1,600 SFGG members. The survey collected 471 responses, 90% of which were from physicians, on knowledge of the current legal framework, positions on changes in legislation, anticipated professional impacts, and patient feedback. Among respondents, 58.6% report having a clear understanding of the current legal framework and applying it regularly, while 39.7% have only partial knowledge of it. Regarding the desired evolution of the law, 27.5% wish to maintain the current legislative framework, and 41.8% of respondents reject all proposed forms of assisted dying. This suggests that the very way the debate is framed may not align with their clinical or ethical perspectives. Should the law evolve, 25.9% would support assisted suicide supervised by a medical team, 17.8% would favor assisted suicide facilitated by an association, 9.1% would support the issuance of a lethal prescription for self-administration by the patient, and 7.2% would favor euthanasia, defined as the direct administration of a lethal substance by a healthcare professional. Only 12.5% reported not having a definitive opinion. In the event of legalization of assisted dying, 48.2% of respondents would consider invoking a conscience clause, 24.0% might consider leaving their position, and 21.9% would be willing to participate in its implementation. Finally, 68.2% believe that the SFGG should take an active part in the public debate. The national French survey highlights a wide range of opinions among geriatric professionals, reflecting both cautious support for certain forms of AD and deep ethical and professional concerns. These findings underscore the need for a well-informed, ethically grounded debate that carefully considers the specific vulnerabilities of older adults.

BACKGROUND:Older and critically ill patients are at risk of delirium in hospital. AIM:To explore the factors associated with and the prognostic value of delirium in older patients in a cardiac intensive care unit (CICU). METHODS:All consecutive patients aged>75years admitted to a CICU from January 2018 to December 2018 were included. RESULTS:The study included 451 consecutive patients (47% male), with a median age of 83 (80-88)years and a median modified Charlson Comorbidity Index score of 1 (1-3). The median left ventricular ejection fraction was 55% (40-60%). The prevalence of delirium at admission was 6.8% (31 patients), and the frequency during the CICU stay was 11.9% (50 patients). Patients with delirium were older (P=0.044), with a history of cognitive disorders (P<0.001), stroke/transient ischaemic attack (P=0.046) and zopiclone use (P=0.001). Sepsis (odds ratio 22.8, 95% confidence interval [CI] 9-65; P<0.001) and cardiogenic shock (odds ratio 3.9, 95% CI 1.29-11.48; P=0.007) were pathological conditions present in patients with delirium. Geriatric factors associated with delirium were faecaloma (P=0.008), acute urinary retention (P=0.010), urinary catheter instauration (P<0.001) and opioid use (P=0.002). Patients with delirium had a longer CICU length of stay (3 (2-5) versus 2 (1-3) days; P<0.001) and a longer in-hospital length of stay (11 (5-21) versus 7 (3-12) days; P<0.001). In the multivariable analysis, delirium was associated with a higher risk of in-hospital death (hazard ratio 3.79, 95% CI 1.55-9.31: P=0.005), adjusted for N-terminal prohormone of B-type natriuretic peptide concentration. CONCLUSIONS:The onset of delirium in older patients affects prognosis in the CICU. Physicians must search for geriatric factors, sepsis and cardiogenic shock in the context of delirium.

Hematological cancers (leukemia, lymphoma, and myeloma) are affecting more and more elderly people, and therapeutic innovations are making it possible to treat a greater number of patients who were previously rejected for treatments considered too intensive. The purpose of comprehensive geriatric assessment (CGA) is to screen for frailty and geriatric syndromes in order to adapt hematological treatment and implement supportive care, particularly nutritional and rehabilitative care, to support the overall management of the patient. The EGA is based on scores such as the G8 or VES13, as well as the creation of mixed scores specific to certain blood disorders, such as the IMWG for myeloma or the AML-CM for leukemia, which combine biological and geriatric criteria to establish prognostic groups. Longitudinal studies with comprehensive EGAs and joint hematological-geriatric follow-up are still needed to clarify the geriatric syndromes that have the greatest impact on survival.